Minimally Invasive Posterior Cervical Fusion Strategies

Thoracolumbar minimally invasive spine surgery (MIS) has become widely adopted over the past two decades. MIS cervical fixation has lagged behind, largely because of complex and variable cervical spinal anatomy. Traditional open spine fixation techniques are associated with high fusion rates but are plagued by significant approach-related morbidity. This morbidity is due to paraspinal muscle denervation and atrophy secondary to disruption of the posterior musculoligamentous complex leading to wound healing difficulties, including relatively high rates of wound infection and dehiscence as well as aesthetic issues. Therefore, novel MIS fixation techniques have focused on percutaneous tissue-sparing approaches in an effort to decrease wound morbidity and hospital readmission. In addition, more biomechanically robust minimally invasive constructs may provide smaller alternative surgical solutions. Previously described fluoroscopic MIS cervical pedicle screw placement has been revitalized with the recent description of a navigated percutaneous minimally invasive technique. With the incorporation of new enabling navigation technologies, this technique is feasible, reproducible, and safe. In addition, these procedures have provided unique solutions for approaching cervical pathology in line with currently accepted MIS principles of the thoracolumbar spine. This review article discusses current minimally invasive posterior fusion strategies with a description of the technique and case demonstrations.